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12 Enforcement and Compliance Predictions for 2012

By Frank Sheeder on Posted in Culture, DOJ, Enforcement, Government Initiatives, ICD, Implantable Cardiac Devices, Long Term Care, Medicaid, Medicare, OIG, Reform, Settlements

This has been an interesting year for the health care industry, and I believe the coming year will be even more exhilarating.  Here are my 12 enforcement and compliance predictions for 2012.  Please comment with yours.  We’ll see how we do. . . .   Regardless of what happens with the health care reform law, the current market forces… Continue Reading

A 10-Year Old’s View of Health Care Enforcement

By Frank Sheeder on Posted in DOJ, Enforcement, Fraud, Medicaid, Medicare, OIG, Reform

My Daughter’s Depiction of Health Care Enforcement — I Call it Enforcica  — One of the more challenging and rewarding aspects of being a health care attorney is taking a complex regulated environment and breaking it down in a way that is understandable, regardless of the audience.  In the compliance world, this means communicating the rules… Continue Reading

Heads Up! HHS-OIG is Emphasizing Medicaid Enforcement

By Frank Sheeder on Posted in Enforcement, Government Initiatives, Medicaid, OIG, Uncategorized

I have been saying for a while that there will be a renewed emphasis on Medicaid enforcement.  Here’s some more objective evidence of this trend:  The HHS-OIG has published Proposed Revisions of Performance Standards for State Medicaid Fraud Control Units. The current standards were promulgated in September 1994, in the aftermath of the last big health care… Continue Reading

Update: OIG’s Intensive Hospital Audits

By Frank Sheeder on Posted in Enforcement, Government Initiatives, OIG

We addressed the OIG’s ongoing intensive hospital audits in two previous posts: OIG Has New, Intensive Hospital Compliance Initiative, and More About OIG’s Intensive Hospital Audits — Required Reading.  This post updates those discussions based on some recent audit reports. OIG has audited some new issues: Inpatient claims with same-day discharge and readmissions. Inpatient claims for 1-day… Continue Reading

HHS Redoubles its Data Prospecting Efforts

By Frank Sheeder on Posted in CMS, Enforcement, False Claims Act, Government Initiatives, ICD, Implantable Cardiac Devices, Medicare, OIG, Reform

In previous posts, I have mentioned the government’s “data prospecting” efforts, and highlighted the difference between “data mining” and “data prospecting.”  Mining is done when you already know where to dig.  Prospecting, which is what the government has been doing, involves finding out where to dig.  There’s a big difference, and the implications should not… Continue Reading

View the OIG HEAT Provider Compliance Training Webcast

By Frank Sheeder on Posted in Administration, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, Reform

OIG has posted a webcast of its HEAT Provider Compliance Training.  It is 3 hours, 45 minutes long.  I will post a summary in the near future.  There is also an OIG HEAT Provider Compliance Training Website at which you can download the corresponding slides and related materials. Get Instant Updates by Email

OIG’s HEAT Provider Compliance Training

By Frank Sheeder on Posted in Administration, CMS, DOJ, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, Stark Law

Since February 2011, members of the HHS Office of Inspector General (OIG) and their colleagues have been presenting HEAT Provider Compliance Training across the country.  The most recent training included a live webcast with slides.  The OIG has committed to posting a link to the webcast by the end of May.  In the meantime, the slides… Continue Reading

The More Things Change — Parallels Between Clinton and Obama’s Messages

By Frank Sheeder on Posted in Administration, Enforcement, Government Initiatives, OIG, Reform

I was doing some research and came across something interesting.  In September 1993, there were news articles across the country like:  “Clinton Positioned to Crack Down on Fraud if Health Care Plan Passes.”  In March 2010, there were articles to the effect:  “Obama Gets Tough on Health Care Fraud.”  Just this week, we have two… Continue Reading

More About OIG’s Intensive Hospital Audits — Required Reading

By Frank Sheeder on Posted in Administration, Enforcement, False Claims Act, Government Initiatives, Medicare, MSP, OIG

In a previous post, OIG Has New, Intensive Hospital Compliance Initiative, I described the 4- to 6-week onsite audits that the OIG’s Office of Audit Services has initiated at several hospitals across the country.  Several readers asked for more details, so here they are.  This is another example of required reading. . . . The… Continue Reading